Correlation Between Immunocompromised Host Pneumonia and Lymphocyte and Influence of Glucocorticoid on Outcome of Severe Patients
10.13471/j.cnki.j.sun.yat-sen.univ（med.sci）.2022.0613
- VernacularTitle:免疫抑制宿主肺炎与淋巴细胞的相关性及激素对重症患者结局的影响
- Author:
Yan-ru WU
1
;
Mian ZENG
1
Author Information
1. Medical Intensive Care Unit， The First Affiliated Hospital of Sun Yat-sen University， Guangzhou 510080，China
- Publication Type:Journal Article
- Keywords:
immunocompromised host;
pneumonia;
T lymphocytes;
risk factors;
glucocorticoid
- From:
Journal of Sun Yat-sen University(Medical Sciences)
2022;43(6):976-984
- CountryChina
- Language:Chinese
-
Abstract:
ObjectiveThe purpose of this article is to explore the relationship between lymphocyte and the severity of immunocompromised host pneumonia， and to examine the effect of different doses of glucocorticoid on the survival outcome of severe group. MethodsThe clinical data of immunocompromised host pneumonia patients were collected. The patients were divided into severe group and non-severe group according to the official clinical practice guideline of the ATS/IDSA. Logistic regression analysis was used to search for independent risk factors of severe immunocompromised host pneumonia. Meanwhile， the receiver operating characteristic curves （ROCs） were created to evaluate the predictive value of each risk factor. Furthermore， the severe group were divided into three sub-groups according to the dose of glucocorticoid during hospitalization： severe+ high-dose glucocorticoid group （≥1 mg·kg-1·d-1 prednisolone or other equivalent dose of glucocorticoid）， severe+ low-dose glucocorticoid group （＜1 mg·kg-1·d-1 prednisolone or other equivalent dose of glucocorticoid）， and severe+ non-glucocorticoid group. The 28-day survival rates of the three groups were compared to evaluate the effect of glucocorticoid on severe immunocompromised host pneumonia. ResultsThe levels of lymphocyte absolute value， T lymphocytes percentage， T lymphocyte absolute value， CD4+T lymphocyte absolute value in severe pneumonia group were lower than those in non-severe pneumonia group. The results of logistic regression showed that the increase of CRP and PCT and the prolongation of PT were independent risk factors for the severe immunocompromised host pneumonia， while the increase of platelet and T lymphocyte absolute value were independent protective factors for the severe immunocompromised host pneumonia. The ROCs analysis showed that compared with other risk factors， the decrease of T lymphocyte absolute value had better predictive value for the risk assessment of immunocompromised host pneumonia. When the absolute value of T lymphocytes was lower than 874.65 cells /μL， the sensitivity and specificity were 90.9% and 43.5%， respectively. The area under the curve （AUC） was 0.723 ［95% confidence interval （0.649， 0.797）］. The survival rate of the severe + high-dose glucocorticoid group was 45.5%. The survival rate of the severe + low-dose glucocorticoid group was 66.7%. The survival rate of the severe + non-dose glucocorticoid group was 25.0%. The survival rate of the severe + low-dose glucocorticoid group was higher than the survival rate of the severe + non-dose（P＜0.05）. Meanwhile， the survival rate of the severe + low-dose glucocorticoid group was higher than the survival rate of the severe + high-dose glucocorticoid group， but no statistically significant difference was found （P>0.05）. ConclusionsThe increase of T lymphocyte absolute value is the independent protective factor for immunocompromised host pneumonia. The absolute value of T lymphocytes have a good predictive value for the severity of immunocompromised host pneumonia. When the absolute value of T lymphocytes is lower than 874.65 cells/μL， the sensitivity is up to 90.9% . Low-dose glucocorticoid therapy can improve the 28-day survival rate of patients with severe immunosuppressive host pneumonia.
